Osawa Takeshi, Shirasaki Shinji, Tamamura Hiroyasu, Hinoshita Tetsuya
Department of Surgery, Tannan Regional Medical Center, Fukui Prefectural Hospital.
Gan To Kagaku Ryoho. 2010 Jul;37(7):1393-5.
We report a case successfully treated with multidisciplinary treatment against recurrence of lateral lymph node and liver for rectal cancer. The patient was a 61-year-old man with lower rectal cancer (moderately-differentiated tubular adenocarcinoma). Low anterior resection with D2 (prxD2) lymph node dissection was performed. Final findings were pA, pN1, sH0, sP0, cM0, fStage IIIa, and S-1 was given as postoperative adjuvant chemotherapy. Seven months after surgery, recurrence of the right lateral lymph node (283rt) was detected on abdominal CT and PET-CT (SUVmax 23.6). Chemotherapy with FOLFOX4 was performed. However, because of elevated CEA, concurrent chemoradiotherapy with FOLFOX4 and radiation (60 Gy) was performed. Though CEA decreased once after chemoradiotherapy, it rose again in chemotherapy with FOLFOX4. The chemotherapy regimen was changed to FOLFIRI. Then, CEA decreased to the normal level. Eight courses of FOLFIRI and five courses of FOLFIRI plus bevacizumab were performed. Thereafter, chemotherapy with CPT-11 was continuously performed. Twenty months after surgery, no abnormal uptake was detected on PET-CT. Twenty-six months after surgery, radiofrequency ablation was performed for a small hepatic metastasis (2 cm or less in diameter). Thirty-nine months after surgery, no recurrence was detected on abdominal CT and the CEA level was normal.
我们报告了一例直肠癌侧方淋巴结及肝脏复发经多学科治疗成功治愈的病例。患者为一名61岁男性，患有低位直肠癌（中分化管状腺癌）。行D2（近端D2）淋巴结清扫的低位前切除术。最终结果为pA、pN1、sH0、sP0、cM0、fStage IIIa，术后辅助化疗给予S-1。术后7个月，腹部CT及PET-CT检查发现右侧方淋巴结（283rt）复发（SUVmax 23.6）。给予FOLFOX4化疗。然而，由于癌胚抗原（CEA）升高，遂行FOLFOX4同步放化疗及放疗（60 Gy）。放化疗后CEA一度下降，但在FOLFOX4化疗时又再次升高。化疗方案改为FOLFIRI。此后，CEA降至正常水平。共进行了8个疗程的FOLFIRI及5个疗程的FOLFIRI联合贝伐单抗治疗。此后，持续给予伊立替康（CPT-11）化疗。术后20个月，PET-CT未发现异常摄取。术后26个月，对一个小的肝转移灶（直径2 cm或更小）进行了射频消融治疗。术后39个月，腹部CT未发现复发，CEA水平正常。
